Objective: To identify the cortical and subcortical distribution of atrophy and the disorganization of white matter bundles underlying the apraxic disorders in a patient with corticobasal degeneration (CBD). Method: Patient underwent appropriate neuropsychological tasks aimed at identifying the nature of the apraxic disorder and morphometric structural MRI with whole-brain voxel-wise analysis. Results: Progressive limbkinetic apraxia (LKA) with onset in the right upper limb with subsequent extension to the limbs, trunk, orofacial district, and eye movements was documented, associated with element of ideomotor apraxia (IMA). The MRI study showed grey matter atrophy extending to much of the frontal cortex bilaterally, including the precentral cortex, and into the inferior parietal regions. Caudate and putamen were involved on the left. Significant clusters of white matter atrophy were found in the bilateral superior longitudinal fasciculus (SLF), inferior longitudinal fasciculus (ILF) and corpus callosum (CC). Sensory evoked potentials (SEPs) and motor evoked potentials (MEPs) were normal. Conclusion: Previous observations in CBD indicate lack of inhibitory control from the sensory to the primary motor cortex with dysfunctional frontoparietal and cortico-motoneuron projections. Our neuroimaging data are partially consistent with these observations suggesting that the apraxic disorder in our patient might be produced by the disconnection of the primary motor cortex from the parietal areas that prevents selection and control of muscle movements, in the presence of preserved cortico-motoneuron as demonstrated by normal PEM. Apraxic disorders in CBD are high-level deficits of movement control that spare the motoneuron.

Frontotemporal dementia: Addressing the scattered harbingers of genetics and its relationship with glucose metabolism, bipolar disorder, and amyotrophic lateral sclerosis

Purpose: This case–control study sought to determine if (a) children with childhood apraxia of speech (CAS), other speech sound disorders (SSDs), and typical development would perform differently on a procedural learning assessment and (b) whether grammatical ability would impact group differences.Method: Communication, motor, and procedural learning abilities were assessed in 48 children with CAS (n = 13), SSD (n = 20), and typical development (n = 15), between 43 and 97 months of age (M = 66 months, SD = 12 months).Results: On average, children with CAS demonstrated grammatical and motor impairments and required an increased number of exposures to the visuospatial sequence to demonstrate procedural learning, compared to peers with SSD or typical development. A subset of children from each group demonstrated an unanticipated procedural learning pattern wherein they evidenced an uptick in reaction time during the second sequenced block. Children with CAS with this pattern still evidenced procedural learning gains by the fifth sequenced block. In contrast, children with SSD and typical development with this pattern showed poor procedural learning outcomes and were characterized by lower scores on language and motor assessments as well.Conclusions: This research provides partial support for the procedural learning deficit hypothesis in children with CAS and for a subset of children with SSD as well. Future research should examine the role of a serial reaction time task in identifying children at risk of multisystem communication and motor deficits.Supplemental Material S1. STROBE Statement—Checklist of items that should be included in reports of case-control studies. Iuzzini-Seigel, J. (2021). Procedural learning, grammar, and motor skills in children with childhood apraxia of speech, speech sound disorder, and typically developing speech. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2020_JSLHR-20-00581

Purpose: The aim of this study was to determine the discriminative features that might contribute to differentiation of childhood apraxia of speech (CAS) from other speech sound disorders (SSDs).Method: A comprehensive literature search was conducted for articles or doctoral dissertations that included ≥ 1 child with CAS and ≥ 1 child with SSD. Of 2,071 publications screened, 53 met the criteria. Articles were assessed for (a) study design and risk of bias; (b) participant characteristics and confidence in diagnosis; and (c) discriminative perceptual, acoustic, or kinematic measures. A criterion was used to identify promising studies: American Academy of Neurology study design (Class III+), replicable participant descriptions and adequate confidence in diagnosis (≥ 3), and ≥ 1 discriminative and reliable measure.Results: Over 75% of studies were retrospective, case–control designs and/or assessed English-speaking children. Many studies did not fully describe study design and quality. No studies met the Class I (highest) quality rating according to American Academy of Neurology guidelines. CAS was mostly compared to speech delay/phonological disorder. Only six studies had diagnostic confidence ratings of 1 (best). Twenty-six studies reported discriminative perceptual measures, 14 reported discriminative acoustic markers, and four reported discriminative kinematic markers. Measures were diverse, and only two studies directly replicated previous findings. Overall, seven studies met the quality criteria, and another eight nearly met the study criteria to warrant further investigation.Conclusions: There are no studies of the highest diagnostic quality. There are 15 studies that can contribute to further diagnostic efforts discriminating CAS from other SSDs. Future research should utilize careful diagnostic design, support replication, and adhere to standard reporting guidelines.Supplemental Material S1. Rating data. Supplemental Material S2. Excluded articles at the eligibility stage. Supplemental Material S3. Included articles in the analysis.Supplemental Material S4. Five-point rating scale of confidence in diagnosis of childhood apraxia of speech (CAS); five-point rating scale of confidence in diagnosis of all speech sound disorders (SSDs).Murray, E., Iuzzini-Seigel, J., Maas, E., Terband, H., & Ballard, K. J. (2020). Differential diagnosis of childhood apraxia of speech compared to other speech sound disorders: A systematic review. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2020_AJSLP-20-00063

Objetivo: realizar uma revisão bibliográfica sobre o atraso motor de fala não especificado, como ele é avaliado e ainda como se diferencia de outras desordens motoras da fala. Estratégia de pesquisa: Trata-se de uma revisão integrativa da literatura. Realizou-se a busca nas bases SciELO, PubMed, Medine e Scopus no mês de novembro de 2019. Para as quatro bases foram utilizados os seguintes construtos e descritores: “motor speech disorders” OR “childhood apraxia of speech” OR “childhood apraxia of speech cas” OR “developmental dyspraxia” OR “speech sound disorder” AND “speech motor control”, além da utilização de dois filtros: sujeitos até 18 anos e humanos. Critérios de seleção: Artigos publicados em português, inglês ou espanhol foram incluídos, sendo ou não de periódicos de acesso livre. Foram excluídos artigos que não estavam relacionados ao atraso motor de fala não especificado e estudos de revisão de literatura. Resultados: Foram encontrados56 artigos nas bases de dados, sendo 33 da base Scopus, 19 da PubMed, 3 da SciElo e 1 da Medline. Após análise e seleção pelos critérios de inclusão, foram selecionados 14 estudos. Posteriormente a leitura integral dos artigos, 8 estudos foram excluídos, pois não respondiam as perguntas norteadoras da pesquisa, obtendo-se um n de 6 estudos. Conclusão: Muitas crianças com atraso significativo na fala são diagnosticadas erroneamente, sendo o DMS-NOS a desordem de maior prevalência na infância.

Purpose: This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech.Method: Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined.Results: The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics.Conclusions: Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance.Supplemental Material S1. Summary data and statistics for individual participants.Supplemental Material S2. Supplemental figures.Wambaugh, J., L., Kallhoff, L., & Nesller, C. (2020). Sound production treatment for acquired apraxia of speech: An examination of dosage in relation to probe performance. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2020_AJSLP-19-00110Publisher Note: This article is part of the Special Issue: Select Papers From the 49th Clinical Aphasiology Conference.

Apraxia affects 20% of the right brain-damaged patients and 50% of the left brain-damaged patients. This disorder of motor programming reduces patients' independence and there are few guidelines on the rehabilitative treatment in the physiotherapy and speech therapy field.The aim of this study was to assess which therapeutic interventions are the most effective in stroke patients with apraxia in considering the mentioned purviews. Four databases were systematically searched in order to detect all available studies investigating the physical and speech rehabilitation of patients. The literature research produced five studies including 168 patients for the physiotherapy and 50 for speech therapy fields; two were eligible for meta-analysis. Quality was rated with Jadad, PEDro scale and Cochrane Risk Of Bias Tool. Both for physiotherapy and speech therapy fields, the RCTs interventions obtained statistically significant results for outcomes of interest. Despite this, it is still not possible to determine the best approach due to the low number of patients involved, the lack of maintenance of the results at follow up and the timing of the revaluation period being very short to confirm the efficacy of treatments.

espanolEste estudio preliminar tiene por objetivo analizar en que medida los sujetos con apraxia del habla marcan los patrones acentuales que vehiculan valores morfologicos verbales en espanol (amovsamo). Dos grupos de tres participantes (apraxia del habla y control) llevaron a cabo tres tareas: denominacion de frases, lectura de frases y lecturade palabras. Se analizaron las producciones acusticamente (duracion, frecuencia fundamental e intensidad) y se realizo un analisis estadistico mediante modelos de regresion lineal con efectos mixtos para determinar el efecto del grupo, del patron acentual y de la tarea sobre cada parametro acustico. Los resultados muestran una reduccion de los contrastes acentuales en el grupo con apraxia y diferencias en todos los parametros respecto del grupo control. Con todo, los oyentes identifican mayoritariamente el patron acentual meta. Interpretamos los resultados obtenidos a la luz de los debates actuales sobre la apraxia del habla EnglishThis preliminary study sought to investigate whether participants with apraxia of speech are able to mark stress patterns that convey verbal morphological values in Spanish (amovsamo). Two groups of three participants (apraxia of speech and control) performed three tasks (sentence denomination, sentence reading and word reading). Production was analysed acoustically and linear regression models with mixed effects were carried out to determine the effect of group, stress pattern and task on each acoustic parameter. Results show reduced stress contrasts in the apraxic group and inter-group differences for each acoustic parameter. However listeners are globally able to identify the intended stress pattern. We interpret our results in the light of the ongoing debate about apraxia of speech francaisCette etude preliminaire vise a analyser dans quelle mesure les sujets presentant une apraxie de la parole marquent les patrons accentuels quivehiculent des valeurs morphologiques verbales en espagnol (amovsamo). Deux groupes de trois participants (apraxie de la parole et controle) ont realise trois tâches: denomination de phrases, lecture de phrases et lecture de mots. Les productions ont ete analysees acoustiquement (duree, frequence fondamentale et intensite) et une analyse statistique a ete menee a terme mo-yennant des modeles de regression lineaire avec effets mixtes pour determiner l’effet dugroupe, du patron accentuel et de la tâche sur chaque parametre acoustique. Les resultats montrent une reduction des contrastes accentuels dans le groupe apraxique et des differences pour tous les parametres par rapport au groupe controle. Malgre cela, les auditeurs identifient globalement le patron accentuel cible. Nous interpretons les resultats obtenus a la lumiere des debats actuels sur l’apraxie de la parole

Purpose: Verbs with low concreteness are frequent in discourse samples but rarely targeted in aphasia treatments for verbs. These verbs are an important part of functional communication, and recent studies have called for more research regarding aphasia and treatment stimuli with low concreteness. The aim of this study was to pilot the use of verbs with low concreteness in a novel sentence production intervention with persons with aphasia.Method: The study took the form of a single-case experimental design with multiple baselines across behaviors and across participants. Three persons with chronic nonfluent aphasia and apraxia of speech participated in the study. Each participant received treatment designed to increase the semantic networks of verbs with high frequency and low concreteness. Sentence production was closely examined over the course of treatment for treated and untreated verbs of varying concreteness levels. Additional measures of language and cognitive functioning were also taken before and after treatment.Results: Results indicated improved sentence production with target verbs attributable to the treatment in the 1st phase of 2 phases for 2 of the 3 participants. The increases corresponded with the application of treatment, despite the difference in number of baseline sessions for the participants. Where there were treatment effects, there was also considerable generalization to untreated sets of items during the 1st treatment phase. Word retrieval also improved for 2 participants.Conclusions: The results suggest that the novel treatment may improve sentence production and word retrieval in persons with aphasia, even when using target verbs with low concreteness ratings. Future research is warranted into the use of low concreteness verbs.Supplemental Figure S1. Sentence frame for treatment. Supplemental Figure S2. Participants 1–3 sentence repetition probe performance. Supplemental Figure S3. Participants 1–3 discourse generalization probe performance.Supplemental Table S1. Verb stimuli lists for sentence production probes.Supplemental Table S2. Discourse probe stimuli.Supplemental Table S3. Sentence production scoring rubric.Bailey, D. J., Nessler, C., Berggren, K. N., & Wambaugh, J. L. (2019). An aphasia treatment for verbs with low concreteness: A pilot study. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2019_AJSLP-18-0257

Purpose: This retrospective analysis examined group differences in error rate across 4 contextual variables (clusters vs. singletons, syllable position, number of syllables, and articulatory phonetic features) in adults with apraxia of speech (AOS) and adults with aphasia only. Group differences in the distribution of error type across contextual variables were also examined.Method: Ten individuals with acquired AOS and aphasia and 11 individuals with aphasia participated in this study. In the context of a 2-group experimental design, the influence of 4 contextual variables on error rate and error type distribution was examined via repetition of 29 multisyllabic words. Error rates were analyzed using Bayesian methods, whereas distribution of error type was examined via descriptive statistics.Results: There were 4 findings of robust differences between the 2 groups. These differences were found for syllable position, number of syllables, manner of articulation, and voicing. Group differences were less robust for clusters versus singletons and place of articulation. Results of error type distribution show a high proportion of distortion and substitution errors in speakers with AOS and a high proportion of substitution and omission errors in speakers with aphasia.Conclusion: Findings add to the continued effort to improve the understanding and assessment of AOS and aphasia. Several contextual variables more consistently influenced breakdown in participants with AOS compared to participants with aphasia and should be considered during the diagnostic process.Supplemental Material S1. Detailed explanation of statistical models for Research Questions 1–4.Bislick, L., & Hula, W. D. (2019). Perceptual characteristics of consonant production in apraxia of speech and aphasia. American Journal of Speech-Language Pathology, 28(4), 1411–1431. https://doi.org/10.1044/2019_AJSLP-18-0169

En este artículo reviso la formulación de Aristocles de la objeción de inmoralidad dirigida a los pirrónicos (apud Eusebio Praep. Ev. 14.18.18-19), así como una posible respuesta escéptica que transmite esa misma fuente (14.18.20). Con respecto a la objeción, busco mostrar que se trata de un cargo ético y no práctico, que no debe por tanto confundirse con la objeción de la apraxia. Con respecto a la respuesta, argumento que se trata necesariamente de una solución de acionaria, que deja intacta parte de la acusación, simplemente porque el pirrónico no puede ni debe admitir los términos en los que ha sido planteada.

Objective: The purpose of this study was to assess the effectiveness of the combination of two intervention methods, integral stimulation and gestural reorganization techniques in a child diagnosed with developmental apraxia of speech. Method: A 4years old male child diagnosed with childhood apraxia of speech received an intervention for a period of 8months. In the initial phase of 4months duration, integral stimulation approach was used. In the second phase, a combination of integral stimulation and gestural organization was used. A detailed speech and language evaluation were done at 4th and 8thmonth of treatment. Results: Communication developmental eclectic approach to language learning developmental checklist and Kauffman speech praxis test were used to assess the progress at the end of each phase. During the second phase, a rapid increase in vocabulary with reduced speech sound errors and increased sequencing abilities were observed. Results suggest that the combination of integral stimulation and gestural reorganization was an effective intervention in the present case study. Conclusion: Precise motor planning and programming are reflected when the speech production becomes accurate. This single case study supports the involvement of motoric component in childhood apraxia of speech and further research could be done on a larger sample. Keywords: Childhood apraxia of speech, integral stimulation, gestural reorganization, speech sound errors Cite this Article Preethy Susan Reni, Ruth Deborah D. Integral Stimulation and Gestural Reorganization in the Management of Childhood Apraxia of Speech: A Case Study. Research & Reviews: A Journal of Health Professions . 2019; 9(1): 40–44p.

OBJECTIVE: Aim of the modern oncological neurosurgery is to maximize the extent of tumor resection, with a parallel minimization of postoperative neurological deficits; therefore, localization of “eloquent” cortex is essential. Intraoperative Electrical Stimulation (IES) during awake craniotomy is considered the “gold standard” for functional mapping in tumor surgery. In this report we present our preliminary results from a 30-patients series that underwent awake craniotomy. MATERIAL-METHOD: During a 2.5-years period, glioma patients (22 left /8 right hemisphere) underwent awake craniotomy for tumor excision. Bipolar IES conducted with the following parameters: amplitude ranged from 2mA to 6mA, frequency was set at 60 Hz, spatial diameter of stimulation was 0.5mm and the time of stimulation was 1-2 for motor and 4-5 seconds for cognitive-language mapping. Motor and language responses detected through motor and language naming tasks, conducted by a neuropsychologist thought out the operation. RESULTS: Negative motor (upper/lower limbs, tongue arrest, oculomotor apraxia), positive motor (upper limb, fingers, face twitches) and positive sensory (paresthesias) responses were elicited when stimulating premotor areas, primary motor and somatosensory cortex respectively. Speech arrest, phonemic, semantic and anomic errors, and perseverations were produced when left frontal, temporal and inferior parietal lobule areas were stimulated at cortical and subcortical level. Immediate post-operative assessment showed functional deterioration in 50% of patients; 3 months postoperatively all patients but 2 reached their preoperative status. CONCLUSIONS: Awake craniotomy allows resection of tumors in eloquent areas with an acceptable risk of permanent postoperative deficit and should be performed in cooperation with expert clinical neuropsychologists.

Objective To investigate the clinical, neuroimaging and pathological features of patients with corticobasal syndrome (CBS). Methods Three CBS patients underwent neuropsychological assessment, MRI scan, 18F-FDG PET scan, and 11C-PiB PET scan, and the test results were analyzed. Results All three patients showed poor response to levodopa treatment and asymmetric dyskinesia including rigidity, tremor, dystonia and abnormalities in posture and gait.One patient showed apraxia and three patients presented with cognitive impairment.The crania MRI demonstrated mild cerebral atrophy which was slightly more severe in the contralateral side of the initially affected limb.The (18)F-FDG PET/CT scan revealed asymmetric decreased metabolism in the frontal, parietal, temporal, and insular lobe, as well as in basal ganglia.The results of (11)C-PiB) PET showed that amyloid beta-peptide (A Beta) deposition in the cortex was positive in one patient, and negative in the other two patients. Conclusions Corticobasal syndrome is characterized by asymmetric dyskinesia and cognitive impairment, and often associated with apraxia, cortical sensory deficits, and alien limb phenomena.The MRI and FDG PET are helpful for CBS diagnosis, and the PiB PET facilitates the pathological diagnosis. Key words: Pathology; Neuroimaging; Corticobasal syndrome

Walking disorder is the most common sequela in patients with hemiplegia after stroke.More than half of stroke patients can not walk independently after discharge, and still present a gait asymmetry and slow pace, and other abnormalities.Then, the fall risk is increased.With security concerns, patients are more afraid to walk independently and can not complete the walk in community environment.Therefore, gait rehabilitation is considered as the main goal of stroke rehabilitation.Rhythmic auditory stimulation(RAS)is a new rehabilitation method to improve stroke gait.By elucidating the mechanism of RAS and their effects on stroke gait, the aim of this paper is to explore the effective RAS treatment method for hemiplegic patients, so that RAS is not only used in gait training, but also in real-time assessment of gait in any environment for chronic stroke patients. Key words: Acoustic stimulation; Stroke; Gait apraxia

Background Although the early behavioral symptoms of behavioral variant frontotemporal dementia (bvFTD) are prominent, early diagnosis for bvFTD is difficult due to confusion with other mental disorders, and lack of sensitivity and specificity of diagnostic criteria, etc. In this paper, we summarized the important reviews in recent years and analyzed the clinical characteristics of bvFTD patients to improve the detection of early symptoms in bvFTD. Methods Twenty-three possible or probable bvFTD patients were diagnosed according to International Behavioral Variant Frontotemporal Dementia Criteria Consortium (FTDC). Self-designed questionnaires designed by Shanghai Mental Health Center were used to collect sociodemographic data and general information of patients. Their clinical characteristics were summarized, including abnormal behaviors, cognitive impairment, psychotic symptoms and other symptoms. Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL) and Clinical Dementia Rating Scale (CDR) were used to make neuropsychological tests and compare with similar overseas studies (control group, N = 66). Results Eleven male patients and 12 female patients were included in our study. Compared with control group, the average age of onset [(50.83 ± 11.55) years vs. (57.00 ± 10.00) years; t = 3.863, P = 0.000] and average age of diagnosis [(53.22 ± 11.55) years vs. (61.00 ± 9.00) years; t = 13.423, P = 0.000] of bvFTD patients were smaller. The study showed that bvFTD patients had more apathy or indolence [95.65% (22/23) vs. 65.15% (43/66); χ 2 = 8.057, P = 0.005], loss of sympathy or empathy [95.65% (22/23) vs. 33.33% (22/66); χ 2 = 26.499, P = 0.000], while patients in control group showed more derepression behavior [98.48% (65/66) vs. 52.17% (12/23); χ 2 = 27.514, P = 0.000] and continuous, stiff, obsessive and/or ritualized behavior [95.45% (63/66) vs. 30.43% (7/23); adjusted χ 2 = 39.159, P = 0.000]. For cognitive impairment, bvFTD patients presented apraxia [69.56% (16/23) vs. 22.73% (15/66); χ 2 = 16.484, P = 0.000] and executive dysfunction [82.61% (19/23) vs. 59.09% (39/66); χ 2 = 4.156, P = 0.041]. In psychotic symptoms, patients in control group showed hallucination and delusion [33.33% (22/66) vs. 4.35% (1/23); χ 2 = 7.477, P = 0.006]. Conclusions While the behavioral symptoms of bvFTD patients are varied, memory disorder can be one of the primal symptoms. Compared with similar foreign studies, the different composition of behavior symptoms of our bvFTD patients may be caused by cultural differences among evaluators in the understanding of some clinical symptoms in patients. DOI: 10.3969/j.issn.1672-6731.2017.11.010

Rehabilitation of apraxia in adults and children

Appraising Apraxia

T004 Cognitive processes of motor behavior revealed by tDCS

La presence d’une apraxie, notamment apres un accident vasculaire cerebral, est un element limitant l’autonomie de vie au quotidien. Des prises en charge reeducatives sont proposees a la phase aigue et permettent souvent une regression des symptomes. Le propos de cet article est de determiner si l’amelioration constatee en seances peut s’observer au quotidien. A l’aide de trois etudes, nous exposerons les possibilites de generalisation de contenu (c’est a dire que des items non entraines peuvent egalement s’ameliorer apres la prise en charge) et de contexte (l’amelioration est egalement observee en dehors du lieu de la reeducation). En effet, l’enjeu principal de la prise en charge est de rendre service au patient et d’ameliorer son autonomie dans le quotidien.